INTERVENTIONS USED AMONG SCHOOLBASED OCCUPATIONAL THERAPISTS TO PROMOTE

INTERVENTIONS USED AMONG SCHOOL-BASED OCCUPATIONAL THERAPISTS TO PROMOTE STUDENT PERFORMANCE Nichole Campbell, OTS

Learning Objectives ◦ Describe the role of occupational therapy in the school setting ◦ Provide an overview of interventions implemented for students ◦ Explore the relationship between school-based occupational therapy services and student performance

School-Based Occupational Therapy ◦ Contribute to student success in learning environment ◦ Engage students to increase performance and potential (AOTA, 2016; Occupational therapy in the school setting, 2011)

Occupational Therapy Interventions ◦ Address occupational performance areas of concern ◦ Encourage engagement in school ◦ Fulfill role as student ◦ 1: 1 vs. Group and Pull out vs. Push in (AOTA, 2013; Case-Smith & O’Brien, 2015; Causton, 2014; Hofmann, 2016; Kennedy et al. , 2018; Occupational therapy in the school setting, 2011; Smith, Mruzek, & Mozingo, 2016; The American Occupational Therapy Association, 2016; Weintraub et al. , n. d. )

Performance -PEO Model ◦ Form basis for practice in school setting ◦ Person ◦ Student ◦ Environment ◦ School setting ◦ Occupation ◦ Participation in tasks and activities for learning ◦ “Occupational performance results from the dynamic relationship between people, their occupations and roles, and the environments in which they live, work, and play” (Law, Cooper, Strong et al. , 1996)

Framing the Issue ◦ Lack of knowledge between practitioner perceptions of occupational therapy interventions in the school setting in relation to student performance

Purpose ◦ Explore the relationship between perceptions of the role of schoolbased occupational therapy, interventions used most frequently, and the impact on student performance

Research Questions ◦ 1. What is the role of a student and of an occupational therapist in the school setting? ◦ 2. What interventions do occupational therapists use most frequently and what conditions/disabilities/diagnoses do they treat? ◦ 3. How and where is each prevalent intervention chosen and implemented for each student, including supporting clinical reasoning? ◦ 4. What effect does each chosen intervention have on the student's performance in the school setting?

Methods ◦ IRB approval ◦ Design: Qualitative methodological ◦ Practitioner perceptions

Participants ◦ Non-probability purposive sampling ◦ Local school district ◦ Inclusion Criteria ◦ Occupational therapist/Occupational therapist assistant ◦ Currently employed

Data Collection ◦ Online survey sent through email link ◦ Microsoft Forms ◦ Informed Consent ◦ Demographic questions followed by open-ended questions

Data Analysis ◦ Themes among each research question ◦ Connections and relationships between responses ◦ OT in school setting, interventions stated by participants most commonly used, and impact on student performance

Results ◦ Data collected over 6 -week period ◦ Five surveys submitted ◦ Four OT’s ◦ 1 OTA ◦ Demographics ◦ Age ranges from 25 – 43 ◦ All female ◦ All Caucasian ◦ Work setting ◦ 5 – Elementary Schools ◦ 3 – Middle Schools ◦ 1 – High School

Research Question #1 ◦ What is the role of a student and of an occupational therapist in the school setting?

Role of Student ◦ Theme: To learn ◦ Self-help, social, self-care, advocacy, vocational, and academic skills ◦ 1 - “Achieve their maximum ability and potential as a learner” ◦ 3 - “Learn various skills, as well as self-help skills and to connect with others” ◦ 5 - “Be an active member of his/her classroom and learn to the best of their ability”

Role of Occupational Therapist ◦ Theme: Helping, assisting, and providing support for students to achieve maximum ability and independence in the school setting ◦ Address self-care, fine motor, visual motor, perceptual skills, ADL’s, writing, and self-regulation ◦ 1 - “To help students achieve their maximum ability and independence despite their disability in the school setting” ◦ 2 - “Assist the student in accessing their curriculum and school environment” ◦ 3 - “Provide support and evidence based interventions to students and staff to better enable and maximize student participation”

Research Question #2 ◦ What interventions do occupational therapists use most frequently and what conditions/disabilities/diagnoses do they treat?

Interventions ◦ Handwriting and fine motor ◦ 4/5 ◦ Self-regulation and sensory processing ◦ 3/5 ◦ Visual motor, adaptations/compensations, ADL/self-help skills, hand strengthening, and assistive technology ◦ 2/5 ◦ Perceptual motor ◦ 1/5

Conditions/Disabilities/Diagnoses ◦ Autism - all ◦ Down syndrome – all ◦ Fine motor delays ◦ Developmental delays ◦ Specific learning disabilities ◦ Multiple disabilities ◦ Dyslexia ◦ ADHD ◦ Cerebral palsy ◦ Intellectual disabilities

Research Question #3 ◦ How and where is each prevalent intervention chosen and implemented for each student, including supporting clinical reasoning?

Intervention Clinical Reasoning ◦ Theme: First based on what underlying skills need to be improved and what level student is currently at ◦ Evidence-based research ◦ Observation

Intervention Approach ◦ 1: 1 or in occasional small groups ◦ Push in vs. Pull out services ◦ 5 - “I do either pull out or push in, it often depends on the students ability to focus, what is going on in the classroom and what goal I need to work on. ” ◦ 3 - “Some are within the student’s classroom and some are pulled out to therapy room. Location depends on student’s needs, attention, ability to focus, and type of intervention for that day”

Intervention Implementation ◦ Theme: Activity that addresses skill deficits ◦ 3 - “Start with a warm up exercise, implement an activity that addresses the underlying skills required for a certain task, and carry over learned skills into functional activity” ◦ Achieving mastery

Research Question #4 ◦ What effect does each chosen intervention have on the student's performance in the school setting?

Impact of Intervention on Student Performance ◦ Theme: Focus on underlying skills and issues first, which contributes to student performance ◦ 3 - “Interventions are targeted to address the underlying skills/issues. As underlying skills improve, student’s performance and independence will improve. ” ◦ Contribute to completion of school-based tasks ◦ 5 - “The intervention improves the specific skill deficit thus improving the student’s ability to perform in their role as a student”

Discussion ◦ School –based OT’s choose interventions based of the underlying skills issues/deficits of students that need addressed in this setting ◦ Theme: Interventions most commonly used include handwriting and fine motor ◦ Theme: Interventions carried out include push in vs. pull out services along with 1: 1 or small groups (AOTA, 2013; Causton, 2014; Case-Smith & O-Brien, 2015; Cohn & Lew, 2010; Hofmann, 2016; Kennedy et al. , 2018; Pape, Ryba, & Case-Smith, 2004; Piller & Torrez, 2018; Smith, Mruzek, & Mozingo, 2016; Weintraub et al. , n. d. )

Discussion continued… ◦ Theme: Intervention clinical reasoning based on evidence based research and previous observations over time ◦ Theme: Student performance improves through intervention by addressing underlying skills/issues, increasing independence, and enhancing a student’s ability to participate in their role as a student (AOTA, 2013; Causton, 2014; Case-Smith & O-Brien, 2015; Cohn & Lew, 2010; Hofmann, 2016; Kennedy et al. , 2018; Pape, Ryba, & Case-Smith, 2004; Piller & Torrez, 2018; Smith, Mruzek, & Mozingo, 2016; Weintraub et al. , n. d. )

Limitations ◦ Bias ◦ Sample size ◦ Geographic location

Future Research Suggestions ◦ Extended member checks ◦ Additional questions in survey ◦ Conduct similar study comparing findings across geographical locations ◦ Additional research related to perceptions of OT in school setting

Implications for OT ◦ Recognize need for OT within the school setting ◦ Choose interventions that address students’ underlying skills/deficits ◦ Interventions and method of delivery should relate to increasing a student’s ability to perform in the school setting ◦ Strive for academic success

Acknowledgments ◦ School district participants ◦ Faculty advisor, Nancy Carlson, Ph. D. , OTR/L, for her guidance and support

References ◦ AOTA. (2013). What is the role of the school-based occupational therapy practitioner? [Brochure]. Author. Retrieved 2018, from https: //www. aota. org/~/media/Corporate/Files/Practice/Children/Parents. Brochure. pdf March 31, ◦ Case-Smith, J. , & O’Brien, J. C. (2015). Occupational therapy for children and adolescents (7 th ed. ). St. Louis, MO: Elsevier. ◦ Causton, J. (2014). The occupational therapist's handbook for inclusive school practices. Baltimore, MD: Paul H. Brookes Company. Publishing ◦ Cohn, E. S. , & Lew, C. (2010). Occupational therapy’s perspective on the use of environments and contexts to support and participation in occupations. American Journal of Occupational Therapy, 64(Suppl. ), S 57–S 69. http: //dx. doi. org/10. 5014/ajot. 2010. 64 S 57 health ◦ Hofmann, A. O. (2016). What parents need to know about school-based occupational therapy. Retrieved from http: //www. aota. org/About-Occupational-Therapy/Professionals/ CY/Articles/School-consumer. aspx ◦ Kennedy, J. , Missiuna, C. , Pollock, N. , Wu, S. , Yost, J. , & Campbell, W. (2018). A scoping review to explore how universal learning is described and implemented by rehabilitation health professionals in school settings. Child: Care, Health and Development, 44(5), 670 -688. doi: 10. 1111/cch. 12576 design for ◦ Koscinski, C. (2016). The parent’s guide to occupational therapy for autism and other special needs: practical strategies for motor skills, Sensory integration, toilet training, and more (Vol. Second edition). London: Jessica Kingsley Publishers. Retrieved from http: //proxy etown. klnpa. org/login? url=http: //search. ebscohost. com/login. aspx? direct=true&db=nlebk&AN=1160117&site=e host-live ◦ Law, M. , Cooper, B. , Strong, S. , Stewart, D. , Rigby, P. , & Letts, L. (1996). The person-environment-occupation model: a transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9 -23. doi: 10. 1177/000841749606300103

References continued… ◦ Occupational therapy in the school setting. (2011). National Behaviour Support Service, Dublin. ◦ Pape, L. , Ryba, K. , & Case-Smith, J. (2004). Practical considerations for school-based occupational therapists. Bethesda, MD: American Occupational Therapy Association. ◦ Piller, A. , & Torrez, E. (2018). Effectiveness of Occupational Therapy Interventions for Fine Motor Skills in School. Children. American Journal of Occupational Therapy, 72(4). doi: 10. 5014/ajot. 2018. 72 s 1 -po 6037 Age ◦ Rens, L. , & Joosten, A. (2014). Investigating the experiences in a school-based occupational therapy program to inform community-based pediatric occupational therapy practice. Australian Occupational Therapy Journal, 61(3), 148– 158. https: //doi. org/10. 1111/1440 -1630. 12093 ◦ School Settings [Fact sheet]. Retrieved from https: //www. aota. org//media/corporate/files/aboutot/professionals/whatisot/cy/factsheets/school%20 settings%20 fact%20 sheet. pdf ◦ Smith, T. , Mruzek, D. W. , & Mozingo, D. (2016). Chapter 15 - Sensory Integration Theory. In Controversial therapies for autism and intellectual disabilities: fad, fashion, and science in professional practice (2 nd ed. , pp. 247 -266). New York, NY: Routledge. ◦ The American Occupational Therapy Association, Inc. (2016). Occupational Therapy in ◦ Weintraub, N. , Fishman, R. , Sharon, G. , Raanan, R. , Tzadik, R. , Yudovitch, D. , & Winoker, M. (n. d. ). Occupational therapy in the school system position paper [Scholarly project]. In The Israeli Society of Occupational Therapy. Retrieved January 15, 2019, from https: //www. health. gov. il/Units. Office/HD/MHealth/Occupational_Therapy/Documents/OT_School_Syst em_IJO T_EN. pdf